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Cardiac imaging resulted in substantial radiation exposure

Chen J. J Am Coll Cardiol. 2010;doi:10.1016/j.jacc.2010.05.014.

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Procedures involving cardiac imaging led to sizable radiation exposure and effective doses for U.S. patients, according to study findings.

Researchers used administrative claims to identify cardiac imaging procedures in nonelderly insured adults (n=952,420, aged 18-64) in five U.S. health care markets from 2005 to 2007. They estimated 3-year cumulative doses of radiation from these procedures and then calculated population-based annual rates of radiation exposure of effective doses ≤3 mSv/year, >3 mSv/year to 20 mSv/year or >20 mSv/year.

Of the study population, 90,121 (9.5%) patients underwent at least one cardiac imaging procedure using radiation and had a mean cumulative effective dose of 16.4 mSv (range 1.5-189.5 mSv). Myocardial perfusion imaging accounted for 74% of the cumulative effective dose. Overall, the annual population-based rate of receiving an effective dose of >3 mSv/year to 20 mSv/year was 89 per 1,000, and for cumulative doses >20 mSv/year, it was 3.3 per 1,000.

“Cardiac imaging procedures represent an important source of ionizing radiation in the United States,” the researchers wrote. “The overall distribution of cumulative effective doses is skewed and can lead to sizable radiation exposure for many individuals. Better strategies to minimize the radiation exposure from cardiac imaging procedures should be encouraged.”

Matthew J. Budoff, MD, and Mohit Gupta, MD, both of the Harbor UCLA Medical Center, Torrance, Calif., wrote in an accompanying editorial that further research is needed to define the most appropriate risk stratification algorithm that would provide more optimal use of the imaging modalities.

“It is clear that the benefits of treatment of advanced coronary artery disease far outweigh the induced risk of cancer after imaging in this very high risk cohort,” they concluded. “We need to move beyond radiation models, with so many assumptions, to studies documenting the real risk (if any) to the cardiac patient.”

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